Provider Demographics
NPI:1326424011
Name:DR.DAVID HEAVNER & ASSOCIATES
Entity Type:Organization
Organization Name:DR.DAVID HEAVNER & ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OD/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:HEAVNER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:301-862-4718
Mailing Address - Street 1:45155 FIRST COLONY WAY
Mailing Address - Street 2:
Mailing Address - City:CALIFORNIA
Mailing Address - State:MD
Mailing Address - Zip Code:20619-2416
Mailing Address - Country:US
Mailing Address - Phone:301-862-4718
Mailing Address - Fax:301-862-3420
Practice Address - Street 1:45155 FIRST COLONY WAY
Practice Address - Street 2:
Practice Address - City:CALIFORNIA
Practice Address - State:MD
Practice Address - Zip Code:20619-2416
Practice Address - Country:US
Practice Address - Phone:301-862-4718
Practice Address - Fax:301-862-3420
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-04
Last Update Date:2015-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA0884152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDT48102Medicare UPIN